Provider Demographics
NPI:1912462243
Name:BENULIS, MONICA BREANN (CRNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:BREANN
Last Name:BENULIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:PA
Mailing Address - Zip Code:17925-8836
Mailing Address - Country:US
Mailing Address - Phone:570-617-9587
Mailing Address - Fax:
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily